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Biomedical subjects

Marcus Plescia

Publications and source records attributed to Marcus Plescia.

12 recordsLinked to original sources
PubMed2006

A lay health advisor program to promote community capacity and change among change agents.

The Charlotte REACH 2010 project focuses on cardiovascular disease and diabetes among African Americans in a geographically defined community. The goal of the project is to create changes in individual behaviors, community capacity, change agents, and systemic policies and actions that will result in the reduction of health disparities related to cardiovascular disease and diabetes. The project consists of three main components: lay health advisors as change agents, targeted interventions (exercise, nutrition, smoking cessation, primary care), and environmental and systemic interventions. The purpose of this article is to describe the lay health advisor intervention using qualitative methodologies that were developed to document changes in community capacity and change among change agents. Lay health advisors report that they have internalized their role as a community advocate and have made positive changes in their own personal health behavior. Their understanding of the underlying causes of poor health has expanded to include social and institutional factors and they have begun to shift their emphasis toward advocacy for social and institutional change.

Black or African American↗
PubMed2005

Statewide community-based health promotion: a North Carolina model to build local capacity for chronic disease prevention.

BACKGROUND: Public health faces major challenges to building state and local infrastructure with the capacity to address the underlying causes of chronic disease. We describe a structured statewide approach to providing technical assistance for local communities to support and develop health promotion capacity. CONTEXT: Over the last two decades, the North Carolina Statewide Health Promotion program has supported local approaches to the prevention and control of chronic disease. In 1999, a major change in the program required local health departments to focus on policy-change and environmental-change strategies for addressing three major risk factors: physical inactivity, poor diet, and tobacco use. METHODS: State program consultants provided technical assistance and training opportunities to local programs on effective policy-change and environmental-change strategies and interventions, based on needs defined by a statewide monitoring and evaluation system. CONSEQUENCES: The percentage of health departments in North Carolina with interventions addressing at least one of three targeted risk factors in 2004 approached 100%; in 2001, this percentage was 62%. Additionally, between 2001 and 2004, the number of health departments reporting policy or environmental outcomes related to these risk factors almost doubled. INTERPRETATION: Requiring local programs to implement policy-change and environmental-change interventions that address the three major behavioral risk factors provides an organized framework for accountability. An established reporting system guides technical assistance efforts and monitors their effectiveness based on standardized objectives that address the full scope of the socioecologic model.

Chronic Disease↗
PubMed2004

A regional health care system partnership with local communities to impact chronic disease.

Regional health care systems have significant opportunities to adopt community-oriented approaches that impact the incidence and burden of chronic disease. In 1998, a vertically integrated, regional health care system established a community health institute to identify, understand, and respond to health needs from a community perspective. The project was implemented in four communities (two rural counties, a rural/urban transitional county, and an inner-city community) using five steps: 1) support or form a local community coalition; 2) hire and support a local coordinator; 3) prepare a formal community assessment; 4) fund locally designed interventions; and 5) evaluate each project. In four narrative case studies, we present the steps, challenges, and common principles faced at the local level by Carolinas Community Health Institute. The case studies were prepared using three data sources: reviews of written documents, interviews with the seven-member steering committee, and interviews with six key informants from each county. Data were coded and analyzed using standard qualitative software to identify common themes and sources of variance between cases. The project model was generally well accepted. Local autonomy and domain disputes were challenges in all four sites. Funding for local projects was the most frequently cited benefit. The project was successful in increasing local capacity and supporting well-designed interventions to prevent chronic disease. This approach can be used by large health care systems and by other organizations to better support local health initiatives.

Academies and Institutes↗
PubMed2004

A qualitative assessment of Charlotte REACH: an ecological perspective for decreasing CVD and diabetes among African Americans.

An ecological perspective of health promotion was used as the framework for a Charlotte community-based intervention to eliminate rates of health disparities in cardiovascular disease and diabetes. Interventions are targeted on 5 levels of influences, with interaction between levels creating a supportive system for sustained change. The purpose of this qualitative assessment was to explore changes that have occurred among and between the following levels of influences: intrapersonal, interpersonal, organizational, community, and policy. Data from 10 focus groups were analyzed to identify overarching themes and subthemes. Results support positive changes within and between levels of change. REACH participants reported an increase in knowledge of preventative health behaviors, the development of health-related skills, and the diffusion of knowledge to family. Fellowship was identified as the primary motivator to continue positive health behaviors. Community Lay Health Advisors (LHAs) reported changes in individual health perceptions from disease-to prevention-oriented, and positive community changes, including the establishment of walking groups, and a farmers' market. The REACH program staff reported that collaboration between staff and LHAs was crucial to program success. The results of this assessment provide feedback for improving community health promotion activities and developing program sustainability.

Black or African American↗
PubMed2002

The state of community medicine training in family practice residency programs.

OBJECTIVES: This paper describes the state and nature of community medicine training in family practice residency programs. METHODS: A random sample of 224 family practice residency programs was surveyed about the perceived value of community medicine in their residency, the teaching modalities they use, the extent to which their training provides competency in four defined dimensions of community medicine, and which program characteristics and curricula were predictive of higher perceived competency. RESULTS: The participation rate of our survey was 72%. Respondents ranked professional interest, institutional support, and departmental support highly. Less than half the programs provide instruction in community-oriented primary care (COPC), and less than half rate their department's involvement in the community highly. Most programs report that their training provides at least a moderate level of competency in four defined dimensions of community medicine. Curricular methods that are predictive of perceived competency include health department clinical experiences, home visits, cultural sensitivity training, participation in a longitudinal project, meetings with community leaders, and instruction in COPC. CONCLUSIONS: Community medicine is valued in residency curricula, but there is limited uniformity in curricular content and methods. Active and structured education modalities might be more likely to result in competency in community medicine.

Community Medicine↗
PubMedDate not supplied

A community-oriented primary care demonstration project: refining interventions for cardiovascular disease and diabetes.

BACKGROUND: We describe a community-oriented primary care project that implemented all 5 steps of the formal model. Data are presented on cardiac risk factors, protective behaviors, health locus of control, and stage of readiness for change in an African American community. We discuss the use of these data to refine our health promotion interventions. METHODS: We undertook a cross-sectional study of self-reported health behaviors from a door-to-door household survey of a geographically-defined community. Trained community members administered the survey questionnaire, which was completed in 386 of 557 randomly sampled households (response rate 69.4%). Qualitative discussions of survey results with 2 community groups were taped, transcribed, and analyzed for common themes. RESULTS: Compared with their counterparts, respondents who were older than 65 years (P = .0006), who had hypertension (P <.0001), and who had diabetes (P = .001) had higher mean scores for powerful others locus of control. Rates for physical activity and low-fat diet indicators were low compared with national statistics. Most respondents reported a maintenance stage of change for exercise (46.2%) and diet (57.5%). Group discussions found lack of local exercise resources and high-quality grocery stores to be major barriers to health behavior change. Ministers and physicians were identified as important powerful others. CONCLUSION: This study documents low rates of physical activity and healthy dietary patterns and describes recent interventions to address environmental barriers to behavior change. The association between powerful others locus of control and specific cardiac risk factors has prompted a greater emphasis on developing faith-based interventions and renewing physician-counseling efforts. Stage of readiness for change findings have prompted strategies to disseminate existing diet and physical activity recommendations more effectively.

Black or African American↗
PubMedDate not supplied

Racial disparities in health between white and African American family practice patients: clinical implications.

OBJECTIVE: To identify differences in self-reported health status and prevalence of chronic disease between African American and white patients. STUDY DESIGN: A representative sample of African American and white adult patients from a stratified sample of family practices in North Carolina completed a questionnaire that included self-reported racial status, certain sociodemographic data, health risk factors, chronic conditions, and health status measures. DATA SOURCE: The North Carolina Health Project, a practice-based cohort of adult patients from a representative sample of family practice offices in North Carolina. PRINCIPAL FINDINGS: African Americans report poorer general health status than whites. Obesity insufficient exercise, high blood pressure, and diabetes are more prevalent among African American than white family practice patients, even after adjusting for age, gender, and educational attainment. CONCLUSIONS: This study complements previous evidence of disparities in chronic disease and health risk factors between African Americans and whites, and it highlights specific factors that may be important in the primary care setting. RELEVANCE: By focusing clinical attention on the prevention or treatment of specific factors that are known to be more prevalent among certain racial groups, primary care providers may help to reduce racial differences in healthcare.

Black or African American↗
PubMedDate not supplied

Protecting workers from secondhand smoke in North Carolina.

BACKGROUND: Exposure to job-related secondhand smoke represents a significant, but entirely preventable occupational health risk to non-smoking workers. This article examines trends in smoke-free workplace policies in North Carolina. We also examine whether workers comply with such policies. METHODS: Data from the Census Bureau's Current Population Survey were analyzed from 1992 through 2002. Trends for North Carolina workers are compared with workers nationally and trends are presented by age, race, gender, and type of worker. RESULTS: North Carolina ranks 35th in the proportion of its workforce reporting a smoke-free place of employment. The proportion of workers reporting such a policy doubled between 1992 and 2002. Females were more likely to reporta smoke-free work environment (72.0%, CI +/- 2.6) than males (61.2%, CI +/- 4.6%). Blue-collar (55.6%, CI +/- 5.5) and service workers (61.2%, CI +/- 8.4), especially males, were less likely to report a smoke-free worksite than white-collar workers (73.4%, CI +/- 2.6). Compliance with a smoke-free policy does not appear to be an issue, only 3.2% of workers statewide reported someone had violated their company's nonsmoking policy CONCLUSION: While some progress has been made in North Carolina to protect workers from secondhand smoke, significant disparities exist. Smoke-free policies can make a significant difference in reducing exposure to airborne toxins and their associated diseases, and these protective public health policies have not been shown to reduce business revenues. Much has been done to assure the health and safety of workers through public health policy However, opportunities to protect North Carolina workers from the health effects of secondhand smoke are limited by a preemptive state law.

Adolescent↗